A typical implantable cardioverter defibrillator (ICD) has the capability of providing a variety of anti-tachycardia pacing (ATP) regimens as well as cardioversion/defibrillation shock therapy. Normally, arrhythmia therapies are applied according to a pre-programmed sequence of less aggressive to more aggressive therapies depending on the type of arrhythmia detected. Typically, termination of an arrhythmia is confirmed by a return to either a demand-paced rhythm or a sinus rhythm in which successive spontaneous R-waves are separated by at least a defined interval. When ATP attempts fail to terminate the tachycardia, high-voltage cardioversion shocks may be delivered. Since shocks can be painful to the patient and consume relatively greater battery energy than pacing pulses, it is desirable to avoid the need to deliver shocks by successfully terminating the tachycardia using less aggressive pacing therapies.
The success of a tachycardia therapy depends in part on the accuracy of the tachycardia detection. In some cases, a tachycardia originating in the atria, i.e. a supraventricular tachycardia (SVT), is difficult to distinguish from a tachycardia originating in the ventricles, i.e. a ventricular tachycardia (VT). For example, both the atrial chambers and the ventricular chambers may exhibit a similar tachycardia cycle length when an SVT is conducted to the ventricles or when a VT is conducted retrograde to the atria. Accordingly, accurate classification of a detected tachycardia as VT or SVT is needed in order to properly determine when a therapy is necessary.
Once a need for therapy is determined, it is desirable to select the most effective therapy for terminating a detected tachycardia. Currently available ICDs detect and treat an arrhythmia episode as a new episode independently of any previous arrhythmia history. In some cases, a patient may experience repeated episodes of a tachycardia rhythm that is electrophysiologically similar. It is desirable to select a therapy that is the most effective and least aggressive in terminating the tachycardia on the first therapy attempt. As such, it is desirable to know if a particular tachycardia rhythm, either atrial or ventricular, has occurred in the past and what the past therapy success rate has been.